Trauma Healing Beyond The Prescription Pad with Traci Powell

If you’ve ever watched mental health care drift into quick labels and quicker medication swaps, this conversation will feel like a reset. We sit down with Traci Powell, a dual-certified neonatal nurse practitioner and psychiatric mental health nurse practitioner, to talk about what trauma treatment looks like when it actually works, and what breaks when the system stops listening. Traci shares her own story of depression, panic, and a devastating detour through mainstream care that left her worse, not better, and how that experience reshaped the way she practices trauma-informed psychotherapy as a prescriber. 

From attachment science and early neurobiology to ego states, IFS-informed thinking, EMDR concepts, and the Developmental Needs Meeting Strategy (DNMS), we dig into how unmet developmental needs can keep people stuck in shame, insecurity, and persistent depression. Traci makes a clear distinction between processing a traumatic event and repairing an attachment wound, and she gives a concrete client example that shows exactly why “just treat the anxiety” misses the root. If you care about trauma therapy, complex PTSD, attachment trauma, and the future of PMHNP practice, there’s a lot here to bring back to your clinic. 

We also go straight at nursing culture: stigma, imposter syndrome, burnout, and the reality that nurse suicide rates are higher than most people realize. Traci’s simplest “prescription” is also the hardest thing to protect in modern health care: connection and caring, including caring for ourselves. If you’re a student, new grad, or practicing PMHNP trying to build real psychotherapy skills and avoid the med-check treadmill, you’ll walk away with a practical mindset for finding mentors and community. Subscribe, share this with a colleague, and leave a review with the biggest question you’re still wrestling with.

Let’s Connect

Dr Dan Wesemann

Email: daniel-wesemann@uiowa.edu

Website: https://nursing.uiowa.edu/academics/dnp-programs/psych-mental-health-nurse-practitioner

LinkedIn: www.linkedin.com/in/daniel-wesemann

 Dr Kate Melino

Email: Katerina.Melino@ucsf.edu

 Dr Sean Convoy

Email: sc585@duke.edu

 Dr Melissa Chapman

Email: mchapman@pdastats.com

Transcript

Welcome And Guest Introduction

SPEAKER_03 0:33

Welcome back, everybody, to another episode of Papelow's Goes to I am incredibly excited to introduce our next guest, who I just was saying, as we were before start recording, I think our patch is up the line here. And so it's a great to have Ms. Tracy Powell, who is a dual certified neonate and psych mental health nurse practitioner, the founder of Trauma Healing Nurses and Nurses Healing Nurses. She promotes herself as the trauma psych nurse practitioner. So excited to have her here and get into that conversation as well. She also has been really looking at taking this movement, pushing psychotherapy within the role, and has an upcoming Beyond the Script Conference, which if you're interested in that, please link that in the bio here for the podcast. But it is a dedicated space for psychiatry prescribers and therapists to connect, sharpen their clinical psychotherapy skills, revitalize the relational art of mental health practice. Oof, music to my ears. Thank you and welcome, Tracy, to Peploud's Ghost.

SPEAKER_01 1:32

Thank you. Thanks for having us.

SPEAKER_03 1:34

Absolutely. So let's get into it. I always like to kind of start us off by maybe just kind of taking us back since I don't know you that well and just would love you to introduce yourself to our listeners. Can you take us back to kind of where this idea kind of came from beyond the script and the trap of you know kind of what I would always call kind of the pill mills that are out there or the you know the racing through and speed running of medication checks and things like that. Obviously, that wasn't the idea for Peflow and her visioning of the of the role of advanced practice mental health nurse. So where did you start? Where's what started you this you down this road and

When Care Makes Trauma Worse

SPEAKER_03 2:10

and how did you get to this place, if you wouldn't mind sharing?

SPEAKER_01 2:13

So no, I don't mind at all. My actual own personal journey sent me down this road because I was a psych MP, had been one for many years. You know, I'd done the whole life of degree after degree and certification after certification and be the best that I could be as an Indian nurse practitioner. And in my mid-40-ish, I ended up having a lot of depression and panic attacks. And the reality was I watched the movie Frozen and I saw this movie about this pale blonde chick that had this deep dark secret that she had never told anyone and was being forced to isolate. And it started my journey of finally admitting for years as a child I was molested and grew up in a really tough family that, you know, I had done a good job of kind of packing it away. And something about that movie and other things that happened in my life at that time just kind of ripped the band-aid off. And I was not able to keep it as tucked away as I once did. And so I went down the road of what everybody says, go find a trauma therapist and go find EMDR. And I did that and I got worse. Like I expected it was going to help me get better, but ultimately I attempted to end my life in the treatment. And during that time, I was given labels like treatment resistant. At 46 years old, I was labeled bipolar. I was given antipsychotics and SSRIs. And I am in no way, shape, or form anti-medication, but I am anti-don't listen to the patient and let me just keep throwing things at you because I think I know what's going on and I'm not hearing you. And, you know, I did all the things. It was five, six years that I was in mainstream mental health care doing it all. And it wasn't until honestly, actually, I read a book called Miss America by Day that was about a Miss America from the 1950s. And she had had a similar experience to me. Well, she had the same experience, and started talking about recognizing she called it her night self and her day self. And that that that night self was this child that was stuck inside of her. And it was the first thing that really introduced me to ego states. And I started researching that. And then I started to understand IFS. And that kind of resignated with me. So I did some IFS, but it still bothered me because I was like, I had to want to have to manage this for the rest of my life. I don't understand how I did all this amazing stuff in my life, and this thing cannot get healed. And then I came across something called the developmental needs meeting strategy, which is not a very well-known ego state therapy. But when I read it, I was like, holy crap, this explains me. And I reached out to the woman who created it, and she talked to me for hours that night. And then I went and did three days with her, and my life was completely transformed in three days. And after that happened, I just thought, I've got to get I have to change things. Like there's too many people suffering because of what happened to them. And there's not enough people that understand there are attachment wounds and there are trauma wounds, and there are different ways that we can deal with them and heal them so people can be free. And so that was the beginning of it. And then not long after that, I had a nurse confide in me after hearing my story that she had a suicide plan for two nights later. And that was still in the NICU. Once I had that conversation, that's what I just committed myself to. I'm never not going to talk about this. I understood that one person's spoken story is another person's permission to speak. And we can't live in the shadows. And you know, it's just about getting out there, making connection, and helping people understand that there is a way to heal from it. Some really awful stuff if we go down the right path. So that's the very abbreviated version of the very long story.

SPEAKER_03 6:07

Of course. No, thank you so much for sharing that. That's that's powerful. Thank you. It's uh it definitely highlights the the importance of this work and and maintaining that relationship. So yes, thank you.

Nurse Stigma And Suicide Risk

SPEAKER_03 6:20

Thank you. Appreciate that. I'll turn it over to my colleague Sean.

SPEAKER_02 6:22

Tracy, I'm I'm I'm interested if you could perhaps connect the dots from that personal experience or set of experiences and how that translates to your interest and your passions as it relates to stress within the profession of nursing.

SPEAKER_01 6:38

So one of the biggest things is especially that nurse that I talked to, right? As a nurse practitioner, I don't know if it's like this everywhere, but here, when I re-credentialed, I'd have to check a box that says, I don't have any mental health conditions that affects my job. And the reality is it didn't affect my job. It affected my home life because I held it together at work and then would come home and fall apart. But that just that little box kind of gives the message of don't let anyone know you're struggling. And the reality is, I actually just spoke on a cruise about this. Nurses are struggling. Like the nurse suicide rate is double that of the general population. And I think we tend to push nurses into the shadows because we expect them to be the superheroes and rise above it all and not be human. And the reality is, even if you've never had childhood trauma, my gosh, we all are working in so many traumatic situations at work. And so I just I am a nurse through and through. I love nursing. I'll never tell someone not to go into nursing, but I think you have to protect yourself. And I just have a heart for that because I want nurses to be able to reconnect to the light that they, the reason they went into this and be healthy through the process.

SPEAKER_02 7:50

Yeah, I appreciate that. I I literally was just speaking about something similar the other day on the heels of Nurses Week in a keynote. You know, going back to the work of Aristotle and then Tessman and then Hamric, the you know, Hamric talked about this concept of courage, right? There's three different forms of courage in nursing there's requisite courage, heroic courage, and burdened courage. Requisite courage is the kind of courage that's defined by doing your job. There shouldn't be a ticker-tape parade for you demonstrating that you had to don a mask to go into a negative pressure room to take care of a patient with TB. Heroic courage is that kind of courage that's expected of you when you do something extraordinary. But what we're finding in healthcare, specifically in nursing, is that there's an unrealistic expectation of us demonstrating burden courage. And it sounds like that burden courage creates greater risk for stress injury amongst nurses, which is contextualized by the stigma you speak about, really seems to be disproportionately affecting our oppression. Melissa?

SPEAKER_04 8:54

Yes, thank

Attachment Wounds Beyond Pop Labels

SPEAKER_04 8:55

you. I wanted to go into your background as someone who is dual certified as both a neonatal nurse practitioner and a PMHNP. So, how is your deep understanding of early development and attachment science, as you've mentioned, and neurobiology in the neonatal space shaped the way that you approach adult trauma-informed psychotherapy?

SPEAKER_01 9:19

The way I approach it with my clients.

SPEAKER_04 9:22

Yeah.

SPEAKER_01 9:23

I you know, I bring in a lot of attachment science and helping people understand, you know, that that developing brain all through the years and how those early experiences can affect the way that our brain develops and our relationship with ourselves. And so I look at it from two different perspectives. I'll work with the professionals. I I actually give talks in the NICU still about understanding parents and their attachment wounds and ACEs and how that affects their binding in the NICU. But I also help my clients understand, and I I'm never out to vilify any parents. I think parents, for the most part, do the best they can and don't know when they are bringing their own wounds to the table. And so helping my clients understand how those early experiences can be impacting what they're feeling today and then connecting the dots between those experiences and today so that we can then get to the root of what's going on and heal it.

SPEAKER_04 10:18

Thank you. That's helpful. We actually had a guest a couple of podcasts episodes ago talking about attachment as well. And so my brain is going there. Just one follow-up question. I'm curious if there's any like pop psychology sort of, you know, because attachment theory is all out there on social media and people kind of self-I'm avoiding attachment. I'm this kind of attached. No. Any any sort of challenges with that, or is that actually helpful?

SPEAKER_01 10:45

So to be honest with you, uh, my challenge with it is it's one more label, right? If I label myself, I'm avoidant, I'm anxious, all those things. For me, it's not about the labels, it's about what do we do beyond it. And so if I have an attachment problem, right, it's looking at what got me to this space and then how can I heal it. And the thing that I love about the developmental needs meeting strategy is it posits that we had emotional developmental needs that were not met as children. And when we can go back to that wounded part of ourselves and meet those developmental needs, that part of us heals and grows up. And most importantly, how that part of us know that it's not stuck in the past anymore. And I have so many people who come to me who never had major traumas and they don't understand why they have this persistent depression. And then when we go, but if you didn't have someone that you could talk to, even about a bed at school or somebody's bullying you, those things create a sense of insecurity within us. Or if I have a parent who maybe make puts me down because I don't do well in school, or maybe I'm not the star soccer player, those are all things that can affect how we see ourselves. And then, you know, we grow up and we think, oh, it just must be me. I just must not, you know, have good self-esteem. But that stuff can affect us. And so that's kind of you know how we go into let's look at the developmental emotional needs that weren't met. And the cool thing about it is the person has inside of them exactly what they need to heal that person. We just got to get their most adult self connected to the wounded part of them and give them a new message.

SPEAKER_04 12:17

Thank you. And I've looked up now the developmental needs meeting strategy because I am not familiar with that.

SPEAKER_01 12:23

Yeah. It's I love it. I wish it was out there more. I teach it to as many people as I can. It's part of my fellowship. And it's amazing because I actually have someone who just finished my fellowship and he put the most beautiful post in my Facebook group about how he has a client he has seen for years, and now he has connected this woman to the stuck part of herself and her resource. And now she like in a in one session, she has changed tremendously after years of trying to help her.

SPEAKER_04 12:51

That's so powerful. Thank you. Yeah.

SPEAKER_03 12:54

I agree. Very powerful.

Why A PMHNP Path Makes Sense

SPEAKER_03 12:55

Thank you, Tracy.

unknown 12:56

Yeah.

SPEAKER_03 12:57

My next question, you know, maybe it's coming from a selfish place, but I just I am curious because I do get this asked every once in a while of students who maybe is considering coming, you know, becoming a PMHNP. And as myself, I may not know. I've actually, I would say in my previous life, I was a social worker and did that before getting into nursing and seeing the light and everything. But I'm wondering from your perspective, you know, again, as a neonatal nurse practitioner and as you saw, kind of going back to school and you know, getting further education in this area. Can I ask why you chose nursing? I mean, why why didn't you choose maybe going to psychology or or other places that maybe have more traditional kind of pathways to being a therapist and such?

SPEAKER_01 13:37

So well, so the truth is I wanted the shortest path to where I was going. And getting my psych MP was it. I never went back with the intention of I want to write prescriptions. I went back with I know what I want my practice to be. And here is the other truth. And Melissa can speak to this. I I see a lot of therapy programs just like nursing, right? We go in, we get the general training, but once you graduate, you need to get the specialized training. So all the training I knew I needed, I wasn't going to get in any program. I had to go find the mentors and the techniques I wanted to use and then develop my own framework for how I was going to apply those things with my client. So it really was for me, it was just what's the shortest distance between two points so I can start and get my business open.

SPEAKER_03 14:24

Yeah. And so maybe that's my follow-up question then too. Is that is that always your plan to basically start your own practice and and become the entrepreneur that you are at this time? Or just things kind of line up.

SPEAKER_01 14:36

You're the second person to ask me that this week. I just did another podcast a couple of days ago. And I never, even to this day, I don't see myself as an entrepreneur, which I know is kind of crazy because I work for myself. I went into this because I wanted to help people. And that has been my driving North Star for everything I do. And so now as I teach other psych MPs to do what I do, like that, it's just how do I help more people know how to help more people? So that you know, when I look back to the me of 46 years ago or 46 years old, I can look at her and say, I'm putting people out into the world who are who you needed then. So people don't have to be stuck in a system where you're just not really moving forward. And so I don't know. Yeah, that is why I went back. I knew I wanted to do this. And I what I didn't know is I'd be doing what I'm doing now. I mean, now I don't know if you're aware of this, but I actually started a Facebook group called Beyond Meds, and there's 3,300 Psych MPs in there now. And the whole reason the Beyond the Script Society started and Beyond the Script Live started is because I think there's a revolution happening in Psych MPs, and many people are getting it. There's more, but I don't know what the more is, and please help me understand that so I can help my patients or clients, as I call them, feel. And it's pretty cool to watch what's happening.

SPEAKER_02 16:04

Sorry, so

Nursing’s Anxious Avoidant Culture

SPEAKER_02 16:05

at the risk of painting with too wide of a brush, if if you were to give the nursing profession at large an attachment type, what type would that be? And how best can we work alongside of each other mindful of it?

SPEAKER_01 16:17

Oh, I think they're anxious avoidant.

SPEAKER_02 16:19

Can you explain a little bit more for the for the audience?

SPEAKER_01 16:23

Uh well, I think there's an anxiety that is comes up in people because we have so much imposter syndrome and self-doubt, and we avoid admitting we're struggling. And I, you know, like I mentioned, I actually spoke on a cruise for nurses last week, and there were 3,000 nurses on that cruise. And every talk I gave, it was amazing to see how people realized that they could be vulnerable and open up and say, I'm struggling too, and nobody knows. I had one nurse tell me that she sat in her cabin by herself the whole time. She went on the cruise by herself. She only came out to go to talks and was contemplating ending her life on that cruise and then making that connection with others. Now she's feeling stronger. She was willing to go back and do what she needs to do for herself. So it's it's sad. And I think we just need to find a way to help people not be so anxious and avoid it and to know we're not meant to be superheroes. We're humans.

SPEAKER_02 17:20

Embracing the irony for a second, if I were to challenge you to write a non-pharmacologic prescription for this, how can we work best with each other to navigate this?

SPEAKER_01 17:31

So honestly, for me, it's very, very simple. The word that I always feel like we're missing, there's two words, and this goes back to Pepel and Gene Watson. I love her too. Connection and caring, period. We need to be kinder, we need to be better connected, and we need to care more. And not just about each other, but about ourselves. When we turn away from ourselves, it makes us hard to connect to others. And not for nothing. A lot of people go into nursing because they have had childhood stuff and they're out in nursing trying to heal everybody else because they have their own stuff that's never been taken care of. And so I think there needs to be a balance. And so, you know, that's always my goal is how can I help people connect, feel less alone, and feel empowered because we need some empowerment out there. Systems are disempowering nurses.

SPEAKER_02 18:24

Well said. I

Fast Trauma Processing Meets Attachment Repair

SPEAKER_02 18:25

appreciate that. Good. Thank you.

SPEAKER_04 18:28

So we've been talking about, you know, your more intensive trauma healing framework where you focus on helping adult survivors of abuse and and other trauma quote, unbecome what was never them, which I love, to return to their authentic selves. I wonder if you can maybe give an example or just sort of make concrete how you utilize experiential therapy-informed approaches to help a client process that trauma rather than just treating, you know, a diagnosis like anxiety and depression.

SPEAKER_01 19:03

So when they come in, well, for me, the diagnosis of anxiety and depression are not actually diagnoses, they're symptoms, right? They're a symptom of a much bigger issue, much like if someone came to us with an infection and had a fever. I can focus on the fever, but I'm not gonna help the infection. And so I try to help them get to the root of that. And so when they first come, I have an attachment inventory that I do and we talk about experiences they had as children that may be contributing to what is going on with them. We talk about traumas they may have. And then I use one of two techniques. I actually use a technique that you're not gonna find if you look it up, but I call it rapid integration of traumatic experiences, which is taken from the tenets of EMDR, but is much, much faster. Like I can help someone resolve a trauma experience in minutes, something they've carried for decades. But if there is an attachment wound connected to that, so I'll give you, can I give a quick example? I had a client last week who had an adult experience, she was a realtor who someone had reached out to her and threatened her and was really like saying some really nasty things to her. And it happened about a year ago, she couldn't get out of her head, and it just was this like trauma of seeing his face and the way he acted. And so when I use right for something like that, typically it will discharge the energy quickly, it will help their brain process the trauma and it'll it'll go away. But in this particular case, it wasn't getting better. So then I had to stop her and say, Okay, let's talk about this. Help me understand what's going on inside of you. And she's like, the fear is just getting worse, and I just feel so much shame. And so then the question is to check in with that feeling. Does this feel like your most adult self or does it feel younger? And she was able to say, Yeah, I feel really young. All right, well, let's go into that. Well, what came up was when she was 10, her neighbor molested her, and nobody knew. And so what her brain was connecting was the look on this man's face today was actually connected to when she was 10, her neighbor molested her. She told her father, who's the only person she ever told, he gave her this look of disgust and never dealt with it. So there's the attachment wound. This man who should have loved and protected me looked at me and told me I was a liar. So we had to shift and use the proper. So instead of that trauma technique and like even EMDR, I know there's some attachment protocols that people have written, but EMDR, by and large, is a trauma processing technique. In this case, she needed that attachment wound processed, which is what I use DNMS for. And once we process that and help that little girl know her dad had issues, right? He didn't have what he needed, the skills to give her what she needed. It wasn't about her. And that's a lot of the issue that we have as parts that are stuck think I'm the problem because in your child's brain you decide that. So then helping that child to understand it was never about you. And oh, by the way, you're not a child anymore, you're a grown adult. That helps to free them from that old space that they were sitting in.

SPEAKER_04 22:07

I really appreciate that example. I think that does make it concrete and really brings out how powerful and like the essence of the work that you're doing here. So thank you. Yeah, thanks.

SPEAKER_03 22:19

This has been

Mentors, Private Practice, And Evidence Gaps

SPEAKER_03 22:20

great. Thank you again, Tracy, for for being our guest. And one of the last questions I'll get to and maybe Sean will kind of can wrap us up. But you know, and I think this kind of maybe goes full circle a little bit is you know, thinking about the healthcare system and the continuum pressure, you know, we talked to I talk to my students a lot, especially this time of year, uh, as they're graduating and looking to get new jobs and things like that, and and and doing the work that they actually want to do. I mean, like you said, medications are great, they're life-saving in the right context, but but making that connection and actually developing foundational psychotherapy skills within your practice. What sort of skills or or what sort of things, advice do you have for new grads or even practicing NPs who want to fight for that space to keep practicing that deep relational healing that we've been talking about and Peplaw obviously advocated for?

SPEAKER_01 23:09

So my number one piece of advice is surround yourself with people who think the same way. Because I find, even for as long as I've been doing this, sometimes I'll get in the psych MP groups and forums and I'll see some comments about you shouldn't be doing therapy, and then I will even catch myself going, Why am I doing this? So that is why I started PMH and Ps Beyond Meds. I was hoping maybe one person out there would respond and I would have a connection. So I didn't feel so alone in this. And like I said, here we are, 3,300 strong. So I would say one, come join us at PMH and P's Beyond Meds. You guys are our proof that there are people out there who do believe we should be doing this work and we can do this work. And I personally, and this is just a me thing, but I think nurses are so perfectly poised for this because this is a mind, body, soul issue, right? We understand the neurobiology, we understand the psychology, and we can help people connect their soul and get back to themselves. And so please, please, please surround yourself with the people who are gonna guide you down the path that you want to go. And don't feel like you have to get trapped in a job that you don't necessarily want to begin. Not because you can't do it, but because maybe you just don't have the right mentors in your life.

SPEAKER_03 24:24

Maybe as a follow-up, do you do you think that's why a lot of people do are moving into private practice? And do you have any concern about that kind of trend?

SPEAKER_01 24:33

Of the people I talk to about this, I think that is largely why. Because there's not, I mean, if you look out there, how many jobs really do you see advertise I want a PMHMP, you can come do therapy? They're just not there. And so yeah, I think that's why a lot of people are doing it. And and I think people are tired of seeing a lot of patients in a short amount of time and being burned out and not really being able to have the time and space. The one thing I hear all the time is psych MDs will say to me, My clients ask me all the time, why can't you be my therapist? And they get frustrated because they can't do those things, and that makes them want to pivot.

SPEAKER_02 25:09

Tracy, I'm gonna ask you one final question to sneak it in here. I uh in the paradigm of evidence-based practice, can you point our listeners to any outcome evaluation work that you or others have done in this space that kind of supports this valuable approach to care?

SPEAKER_01 25:23

So, I mean, the honest truth is no, I can't. And DNMS has not been well researched. Certainly, what I'm doing, if somebody wants to come and research what I'm doing, I have all the documentation. My answer to that is always this. And I think we have to balance this. Yes, we need evidence-based care. What I do is rooted in evidence that's out there, it's rooted in theory that's out there, but the evidence we had was rooted in somebody's idea at one time.

SPEAKER_03 25:50

Absolutely.

SPEAKER_01 25:51

And when we get stuck in that box, then it pulls us pulls us away from the connection, right? If I am so convinced that this is what I have to do, because it's what the evidence says, but I have a client in front across from me who I'm not listening to, then we've lost our connection. Yeah. And so what I will say is yeah, there's evidence about EMDR and adaptive information processing. You can read about that. There's evidence, there's stuff you can read about attachment wounds. There's stuff that will tell you that people with complex trauma in childhood don't do well with EMDR.

SPEAKER_02 26:19

So that's really my answer to that. It's well said. And the motivation behind me asking that one obviously is to kind of get underneath it, but also we have a hopefully a large group of doctoral students who are listening to this podcast right now that maybe they can connect with you and look at your information and use that perhaps as a pilot to kind of bridge that evidence-based gap. So those of you are listening, reach out to Tracy if you're interested in moving in that direction to help her quantify what she knows to be true.

SPEAKER_01 26:49

Amen, brother.

SPEAKER_03 26:51

Awesome. Well, we'll leave that flare in the air and just see who who catches upon that light. So thank you, Sean. And thank you, Tracy. Appreciate everyone listening here and excited about our next upcoming guest. So please, as always, and and again, if you want to know more about Tracy, as you mentioned, Beyond the Med on Facebook. She is the trauma psych NP. Go Google her, she'll find her. She's she's everywhere, which is great. And and again, I think you're right, we're we're caught on the you know, this fire is growing, and and let's just kind of feed the flames here. And but thank you for listening on this. Like, comment, and please subscribe to our podcast. And we'll be back soon with a new episode. Take care.